Background Rheumatic diseases, mostly chronic, are highly prevalent, with a big economic impact high. In Spain the prevalence of rheumatic diseases is similar to other chronic diseases such as hypertension and diabetes. This high prevalence has been the reason that in recent years major changes have occurred, leading rheumatologists to perform their daily work in addition to the hospital, at Specialist Care Centers (SCC) and Primary Care Centers as a consultant rheumatologist. We are currently implementing the virtual consultation (VC) as an alternative health care model.
Objectives To describe our experience with the Rheumatology VC. Assess the advantages and disadvantages that VC implies.
Methods Observational retrospective study to assess the Rheumatology VC conducted from April 1, 2013 until December 31, 2013, requested by 44 primary care physicians (PCP) corresponding to 3 health centers, with a reference population of 70,693 inhabitants.
Results A total of 565 VC were performed on a 9-month period (April 2013-December 2013), with a maximum of 5 visits per day and with a commitment to answer within 24 hours. 53% of the VC were resolved without giving the patient an appointment, and represented questions related to the treatment or analytical data. 47% were given an appointment to be assessed in consultation: 67.5% were referred to SCC for suspected degenerative or soft tissue diseases, and 32.4% were referred to the hospital. Of the patients referred to the hospital, 52 (60.4%) had inflammatory and/or connective pathology, 21 (24.4%) soft tissue rheumatism that needed ultrasound testing and 13 (15.1%) pediatric rheumatologic diseases. The VC were answered within 24 hours, there was no waiting list. The benefits that we could appreciate with VC were: almost direct contact with PCP; to help improving the training of PCP in musculoskeletal diseases (eg, how to differentiate mechanical inflammatory pain, among others); to guide the PCP selecting the best additional tests to order before the patients attends the first consultation with the rheumatologist (eg, laboratory tests with CRP, ESR, radiographs, FR, ANA), according to the previous medical records of the patient, allowing the first consultation to be more efficient, and thus, diminish subsequent visits and the waiting list. On the other hand, the major limitation and disadvantage, is that rheumatologist are fundamentally clinical physicians and in this case we are not examining the patient, since we receive the clinical information from the PCP.
Conclusions Our experience with the VC is positive. Despite the major limitation of taking decisions without the patient being present, we have achieved: 1) Almost immediate resolution of PCP doubts, 2) Contribute to improve the PCP training in medical pathology of the musculoskeletal system, 3) Avoid overloading care, 4) More efficient first visits 5) Early detection of inflammatory diseases that really need an specialized evaluation and/or early treatment.
Disclosure of Interest : None declared